Intervention Review

Clinical service organisation for heart failure

  1. Stephanie JC Taylor1,*,
  2. Janine C Bestall2,
  3. Sarah Cotter3,
  4. Margaret Falshaw4,
  5. Sonja G Hood5,
  6. Suzanne Parsons6,
  7. Lesley Wood7,
  8. Martin Underwood8

Editorial Group: Cochrane Heart Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 JAN 2005

DOI: 10.1002/14651858.CD002752.pub2

Database Title

Additional Information

How to Cite

Taylor SJC, Bestall JC, Cotter S, Falshaw M, Hood SG, Parsons S, Wood L, Underwood M. Clinical service organisation for heart failure. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002752. DOI: 10.1002/14651858.CD002752.pub2.

Author Information

  1. 1

    St Bartholomew's and The Royal London School of Medicine and Dentistry, Centre for Health Sciences, London, UK

  2. 2

    St George's Hospital Medical School, Division of Physiological Medicine, London, UK

  3. 3

    Barts and the London, Queen Mary's School of Medicine and Dentistry, (Deceased) , London, UK

  4. 4

    The Limehouse Practice, London, UK

  5. 5

    School of Population Health, Program Evaluation Unit, Melbourne , Australia

  6. 6

    Barts and The London Queens Mary's School of Medicine and Dentistry, Centre for General Practice and Primary Care, London, UK

  7. 7

    Bristol, UK

  8. 8

    Warwick Medical School, Warwick Medical School Clinical Trials Unit, Coventry, Warwickshire, UK

*Stephanie JC Taylor, Centre for Health Sciences, St Bartholomew's and The Royal London School of Medicine and Dentistry, 2 Newark Street, London, E1 2AT, UK. s.j.c.taylor@qmul.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Chronic heart failure (CHF) is a serious, common condition associated with frequent hospitalisation. Several different disease management interventions (clinical service organisation interventions) for patients with CHF have been proposed.

Objectives

To assess the effectiveness of disease management interventions for patients with CHF.

Search methods

We searched: Cochrane CENTRAL Register of Controlled Trials (to June 2003); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to July 2003); CINAHL (January 1982 to July 2003); AMED (January 1985 to July 2003); Science Citation Index Expanded (searched January 1981 to March 2001); SIGLE (January 1980 to July 2003); DARE (July 2003); National Research Register (July 2003); NHS Economic Evaluations Database (March 2001); reference lists of articles and asked experts in the field.

Selection criteria

Randomised controlled trials comparing disease management interventions specifically directed at patients with CHF to usual care.

Data collection and analysis

At least two reviewers independently extracted data information and assessed study quality. Study authors were contacted for further information where necessary.

Main results

Sixteen trials involving 1,627 people were included. We classified the interventions into three models: multidisciplinary interventions (a holistic approach bridging the gap between hospital admission and discharge home delivered by a team); case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); and clinic interventions (follow up in a CHF clinic). There was considerable overlap within these categories, however the components, intensity and duration of the interventions varied.

Case management interventions tended to be associated with reduced all cause mortality but these findings were not statistically significant (odds ratio 0.86, 95% confidence interval 0.67 to 1.10, P = 0.23), although the evidence was stronger when analysis was limited to the better quality studies (odds ratio 0.68, 95% confidence interval 0.46 to 0.98, P = 0.04). There was weak evidence that case management interventions may be associated with a reduction in admissions for heart failure. It is unclear what the effective components of the case management interventions are.

The single RCT of a multidisciplinary intervention showed reduced heart-failure related re-admissions in the short term. At present there is little available evidence to support clinic based interventions.

Authors' conclusions

The data from this review are insufficient for forming recommendations. Further research should include adequately powered, multi-centre studies. Future studies should also investigate the effect of interventions on patients' and carers' quality of life, their satisfaction with the interventions and cost effectiveness.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intense monitoring of patients with chronic heart failure following discharge from hospital - more studies needed.

Patients with chronic heart failure (CHF) are often admitted to hospital as an emergency. The authors looked at 16 clinical trials that tested different ways of organising the care of CHF patients after they leave hospital. Only one of these trials was determined to be of high quality. There was some weak evidence that the intense monitoring of patients following discharge from hospital might improve survival and reduce the number of hospital readmissions. This type of care usually involved home visits and follow up telephone calls from specialist nurses. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

臨床服務介入組織對心臟衰竭病人之影響

慢性心臟衰竭是一個嚴重及常見的住院原因，有幾個不同的疾病處理介入方法(臨床服務介入組織)被提出。

目標

評估對慢性心臟衰竭病人的各種處理介入方法的有效性。

搜尋策略

我們搜尋了註冊於核心Cochrane的控制試驗,及Medline(1996年1月至2003年7月), EMBASE(1980年1月至2003年7月), CINAHL(1982年1月至2003年7月), AMED(1985年1月至2003年7月);SCI expanded(1981年1月至2003年7月); SIGLE(1980年1月至2003年7月);DARE(2003年7月);National Research register(2003年7月); NHS經濟評估資料庫(2001年3月);及文章之參考文獻和相關領域之專家。

選擇標準

比較“專門針對心臟衰竭病人之疾病介入措施”與“普通照顧”之隨機控制試驗。

資料收集與分析

至少兩個回顧性研究獨立地取出資料並分析資料，亦評估了研究的品質。當有需要時，研究的創始者會被諮詢。

主要結論

我們引用了16個試驗,其中包含了1627個病人。我們把介入性治療分成了三種模式:全方位介入(全人照顧,從入院到出院回家後皆包含)；個案照顧介入(病人出院後的密集監控照顧，常是利用電話追蹤及家訪)；診所照顧介入(在慢性心臟衰竭診所追蹤)。儘管三種模式間有相當的重疊性，但照顧介入的組成成分、密集度、及持續期間並不相同。個案照顧介入嘗試降低所有原因引起之致死率但結果並無太大差異(勝算比0.86, 95%信賴區間是0.67至1.10, P值為0.23),雖然如果我們限定分析品質較好的試驗會得到較強烈的證據顯示個案照顧介入降低了致死率(勝算比0.68, 95%信賴區間是0.46至0.98, P值為0.04)，然而個案照顧介入降低因慢性心臟衰竭入院的機會的證據是微弱的。關於個案照顧介入中有效的介入因子是什麼目前並不清楚。唯一關於全方位介入的隨機試驗發現短期內確實可降低心臟衰竭的再入院率。但目前並無確切證據支持診所照顧介入的有效性。

作者結論

從這些回顧性資料並無法形成共識。進一步的研究應包括效力足夠、多中心的實驗。進一步的研究亦應調查這些介入對於病人跟施予照顧者的生活品質及滿意度的影響,及花費成本效益與效用間的關係。

翻譯人

本摘要由臺北榮民總醫院楊凱仲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在心衰竭病人出院後的密集追蹤監控之影響，需要更多的研究。心衰竭病人入院時常常是以緊急狀態入院。作者回顧了16個臨床試驗,這16個試驗測試了病人出院後不同的追蹤照顧方法。其中只有一個試驗被視為高品質的試驗。關於密集監控出院後病人能否改善存活率及減少再入院率，它的證據是微弱的。這種形式的照顧常常包括了專業護士的電訪及家訪。惟目前還需要更多的研究以評判其有效性。

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